Division of EndocrinologyDepartment of Internal Medicine, Room D-443, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Division of EndocrinologyDepartment of Internal Medicine, Room D-443, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
Eur J Endocrinol. 2015 Aug;173(2):119-27. doi: 10.1530/EJE-15-0048. Epub 2015 May 6.
Previously we demonstrated that IGF1 receptor stimulating activity (IGF1RSA) offers advantages in diagnostic evaluation of adult GH deficiency (GHD). It is unknown whether IGF1RSA can be used to monitor GH therapy.
To investigate the value of circulating IGF1RSA for monitoring GH therapy.
DESIGN/METHODS: 106 patients (54 m; 52 f) diagnosed with GHD were included; 22 were GH-naïve, 84 were already on GH treatment and discontinued therapy 4 weeks before baseline values were established. IGF1RSA was determined by the IGF1R kinase receptor activating assay, total IGF1 by immunoassay (Immulite). GH doses were titrated to achieve total IGF1 levels within the normal range.
After 12 months, total IGF1 and IGF1RSA increased significantly (total IGF1 from 8.1 (95% CI 7.3-8.9) to 14.9 (95% CI 13.5-16.4) nmol/l and IGF1RSA from 115 (95% CI 104-127) to 181 (95% CI 162-202) pmol/l). After 12 months, total IGF1 normalized in 81% of patients, IGF1RSA in 51% and remained below normal in more than 40% of patients in whom total IGF1 had normalized.
During 12 months of GH treatment, changes in IGF1RSA did not parallel changes in total IGF1. Despite normalization of total IGF1, IGF1RSA remained subnormal in a considerable proportion of patients. At present our results have no short-term consequences for GH therapy of GHD patients. However, based on our findings we propose future studies to examine whether titrating GH dose against IGF1RSA results in a better clinical outcome than titrating against total IGF1.
我们之前证明 IGF1 受体刺激活性（IGF1RSA）在成人 GH 缺乏症（GHD）的诊断评估中具有优势。目前尚不清楚 IGF1RSA 是否可用于监测 GH 治疗。
研究循环 IGF1RSA 监测 GH 治疗的价值。
设计/方法：纳入 106 例诊断为 GHD 的患者（54 名男性；52 名女性）；其中 22 例为 GH 初治患者，84 例为已接受 GH 治疗并在建立基线值前 4 周停止治疗的患者。IGF1RSA 通过 IGF1R 激酶受体激活测定法测定，总 IGF1 通过免疫测定法（Immulite）测定。滴定 GH 剂量以将总 IGF1 水平维持在正常范围内。
治疗 12 个月后，总 IGF1 和 IGF1RSA 显著增加（总 IGF1 从 8.1（95%CI 7.3-8.9）增加到 14.9（95%CI 13.5-16.4）nmol/L，IGF1RSA 从 115（95%CI 104-127）增加到 181（95%CI 162-202）pmol/L）。治疗 12 个月后，81%的患者总 IGF1 恢复正常，51%的患者 IGF1RSA 恢复正常，而在总 IGF1 恢复正常的患者中，仍有超过 40%的患者 IGF1RSA 仍低于正常水平。
在 GH 治疗 12 个月期间，IGF1RSA 的变化与总 IGF1 的变化并不平行。尽管总 IGF1 恢复正常，但在相当一部分患者中，IGF1RSA 仍低于正常水平。目前，我们的结果对 GHD 患者的 GH 治疗没有短期影响。然而，根据我们的发现，我们建议未来的研究检验，与总 IGF1 相比，根据 IGF1RSA 滴定 GH 剂量是否会导致更好的临床结局。
